Pathophysiology: Cystocele/Rectocele

Sign & Symptoms:

Cystocele
o Urinary frequency and/or
urgency, stress
incontinence, hx of frequent
UTIs, sense of vaginal
fullness, dyspareunia
(painful intercourse),
fatigue, bac and pelvic
pain, bulging of the anterior
vaginal !all
"ectocele
o Constipation and/or the
need to place #ngers in the
vagina to elevate the
rectocele to co$plete
evacuation of feces,
sensation of a $ass in the
vagina, pelvic/rectal
pressure or pain,
dyspareunia, fecal
incontinence, uncontrollable
%atus, he$orrhoids, bulging
of posterior !all
Treatments:
Cystocele
o &nterior colporrhaphy (pelvic
$uscles are shortened and
tightened)
"ectocele
o 'osterior colporrhaphy (pelvic
$uscles are shortened and
tightened)
Intravaginal estrogen (to prevent
atrophy in post$enopausal
!o$en)
(ladder training and vaginal
pessary
)egal excercisies
Transvaginal repair (vaginal $esh
is used to create a sling that
supports the pelvic %oor)
&nterior*posterior repair (treats
both at the sa$e ti$e)
& hysterecto$y $ay be
perfor$ed at the sa$e ti$e as
any of the procedures listed above
Complications:
Co$plications si$ilar to those
associate !/ vaginal
hysterecto$y
+aginal erosion , serious
infection has led to the recall
of so$e surgical $esh
i$plants used to repair pelvic
organ prolapse
-yspareunia (painful sexual
intercourse) is a possible
surgical co$plication due to
surgical alteration of the
vaginal ori#ce
Cystocele . a protrusion of the posterior
bladder through the vaginal !all/ It is caused
by !eaened pelvic $uscles and/or structures/
Rectocele . a protrusion of the anterior rectal
!all through the posterior vaginal !all/ It is
caused by a defect of the pelvic structures, a
di0cult delivery, or a forceps delivery/
Risk Factors:
Cystocele
o 1besity, &dvanced age (loss
of estrogen), chronic
constipation, fa$ily history,
vaginal childbirth,
$ultiparity, increased
abdo$inal pressure,
hysterecto$y (can
contribute to !eaening of
the %oor of the pelvis)
"ectocele
o 'elvic structure defects,
obesity, aging, fa$ily
history, di0cult vaginal
childbirth, necessitation
repair of a tear, forceps
delivery, previous
hysterecto$y
(oth develop in older adult
fe$ales, usually follo!ing
$enopause
1lder adults are $ore
susceptible to constipation and
chronic bearing do!n during
eli$ination, !hich can displace
Diagnostics:
Cystocele
o & pelvic exa$ination reveals a
bulging of the anterior vaginal
!all !hen the client is
instructed to bear do!n,
bladder ultrasound $easures
residual voiding, urine culture ,
sensitivity is used to diagnosis
UTI associated !/ urinary stasis,
and a voiding
cystourethrography is
perfor$ed to identify the
degree of bladder protrusion ,
the a$ount of urine residual
"ectocele
o & pelvic exa$ination reveals a
bulging of the posterior !all
!hen the client is instructed to
bear do!n, and a rectal
exa$ination and/or bariu$
ene$a reveals the presence of
a rectocele
Nursing Care:
'rovide routine post*op care to
prevent co$plications
&d$inister analgesics, anti$icrobials
, stool softeners/laxatives as
prescribed
'rovide perineal care t!ice daily ,
after every urination , bo!el
$ove$ent
&pply icepac to perineal area to
relieve pain , s!elling
2uggest frequent sit3 baths to sooth
perineal area
"eco$$end client drin 45 of %uid
daily, unless contraindicated
Nursing Diagnosis:
Cystocele
o Ine6ective Health $aintenance r/t
de#cient no!ledge regarding
person care, )egel excercises to
strengthen perineal $uscles
o 2tress urginary Incontinence r/t
to prolapsed bladder
"ectocele
o Constipation r/t painful
defecation
o &cute Pain r/t surgical procedure